Use of Laparoscopic Colorectal Resection for Cancer and Short-term Outcome Among Elderly Patients in Urban Community Hospital

INTRODUCTION – Emerging data suggest that laparoscopic colorectal resection for cancerous and precancerous lesions has oncologic outcome comparable to the open approach, with the advantage of earlier postoperative recovery and lower complication rate. The aim of this study was to examine the pattern of its use among patients of advanced age in urban community hospital and the short-term perioperative outcome.

METHODS AND PROCEDURES – We performed a retrospective chart review of all patients who had undergone colorectal resection for cancerous and precancerous lesions between 1/1/2005 and 12/31/2010 in a single urban community hospital in New York. Patients were stratified into 3 groups: age <65, age 65-79 and age ≥80. Comparisons were made between laparoscopic and open cases among and across each age group. Variables thought to influence the choice of laparoscopic vs open technique were examined including ASA class, BMI, and preoperative diagnosis. Short-term outcome measures included length of stay (LOS), surgical site infection (SSI), cardiopulmonary complications, requirement for transfusion, sepsis or septic shock, and 30-day mortality, readmission, or reoperation.

RESULTS – 455 patients were identified among which 269 (59.1%) were female. 163 (35.8%) patients were age <65, 162 (35.6%) patients were age 65-79, and 130 (28.6%) patients were age 80 or above. Laparoscopic resection were performed less frequently in older age groups (58.3% in age <65, 32.7% in age 65-79, and 22.3% in age ≥80). Patients of advanced age were of higher ASA class (ASA III or IV) (28.8% in age <65, 50% in age 65-79 and 76.9% in age ≥80; p<0.0001) and were more likely to have advanced disease at time of surgery (26.6% with stage III/IV cancer in age <65 vs 40% in age ≥80; p<0.04). These were not significantly different between patients who underwent laparoscopic vs open surgery in each age category. Among patients age ≥80, those who underwent laparoscopic surgery had shorter LOS (10.4 vs 14.9 days; p<0.01) and lower 30-day combined readmission, reoperation and mortality rates (10.3% vs 26.7%; p<0.005) than those who had open surgery. Rate of complications between laparoscopic and open group were not significantly different. Most common postoperative complications were related to cardiopulmonary (24% and 28.7% in laparoscopic open groups respectively).

CONCLUSION – Patients of more advanced age who underwent colorectal resection of cancerous and precancerous lesions were of higher ASA class and had more advanced disease. While these patient characteristics remain comparable between the laparoscopic and open surgical group, the short-term postoperative outcome was superior in those who underwent laparoscopic resection as evidenced by shorter LOS and lower readmission, reoperation and mortality within 30 days postop. Laparoscopic colorectal resection for cancer should be considered more often in elderly patients.

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